The Accuracy of Lung Ultrasonography in Diagnosis of Pneumonia in Critically Ill Patient in Comparison with Computed Tomography of the Chest

Abstract Background Chest X-ray (CXR) is the easiest approach in patients with suspected pneumonia, in search for a new infiltrate. However, studies clarified that it has low sensitivity for the diagnosis of pneumonia in comparison to chest computed tomography (CT). But the use of chest CT is not commonly used except for complex cases and cases with failure response to treatment. Lung ultrasonography (LUS), being a fast bedside technique, it has attracted many interests to preform studies to assess its ability to detect pleuropulmonary pathologies generally and pneumonia specifically. Objective To assess the diagnostic accuracy of ultrasonography (US) in the diagnosis of pneumonia when compared to computed tomography (CT). Methods This was a prospective comparative study where 30 patients completed the study in Ain Shams University Hospitals, with mean age of 61.03 ± 12.55 years and more males 23 (76.7%). After US assessment for the diagnosis of pneumonia, chest CT was done to confirm the diagnosis. Accordingly, they were divided into 2 groups. Twenty four patients (80%) were diagnosed with pneumonia “Positive CT group”. Six patient (20%) were not diagnosed with pneumonia “Negative CT group”. Results After plotting ROC curve for the data obtained from US in the diagnosis of pneumonia in comparison to the chest CT as a gold standard, US was considered a valuable tool to detect the diagnosis of pneumonia (p ˂0.042, accuracy 83%). It had extremely adequate results with sensitivity (100.0%) and specificity (16.7%). It showed excellent accuracy of 83%. The presence of one of the following four profiles in the ultrasound: (A + PLAPS, A/B, B’ or C profile) was used in the diagnosis. A + PLAPS profile showed 37.5% and 83.3%for sensitivity and specificity, respectively, A/B profile 20.8% and 100% B’ profile12.5% and 100 % and C profile:20.8% and 100%. Conclusion According to the results of this study, ultrasonography showed high sensitivity and specificity, so it is considered a bedside, reliable, rapid and non- invasive technique. The results suggest that it could have a significant role in the diagnostic workup of pneumonia in the ICU, alongside with the computed tomography.